CERVICAL DISC HERNIATION DIAGNOSIS AND TREATMENT OPTIONS
HOW IS A CERVICAL HERNIATED DISC DIAGNOSED?
When a patient makes an appointment presenting with pain potentially caused by a herniated disc the surgeon starts with a complete history and physical examination. It is essential for the surgeon to piece together the patient’s story of how the pain or problem began while looking for clues to what is causing the pain. A spine surgeon usually uses four distinct tests to identify the cause of a patient’s pain in the cervical or neck area.
- MRI (Magnetic Resonance Imaging) Scan – After the initial exam, the surgeon will typically order an MRI scan. This scan can show the surgeon any nerve root or spinal cord compression that may correlate with the patient’s symptoms.
- Computerized Tomography (CT Scan) – In addition to the MRI, a surgeon may occasionally order a CT Scan with or without myelogram, a slightly more sensitive and invasive test. Mylegram dye is injected into the spinal canal to further enhance the imaging of the spinal cord and can show more definitely the compressed areas of the spinal canal.
- Pain Management Injections – Surgeons often refer the patients for pain management diagnostic injections. These injections have a therapeutic benefit, as well as help pinpoint the pain generator or cervical level that is causing the patient’s pain. If a patient does get temporary relief, but the pain comes back, patients are often referred for least invasive procedures that can reduce and eliminate the cervical pain.
- EMG (Electromyography) – An EMG is another helpful test performed often by neurologists and some pain and physical medicine specialists. This electrical test stimulates selective nerves by inserting small needles into muscles in the arms that may be affected by a compressed nerve in the spine. If the muscles have lost normal innervation, there will be spontaneous electrical activity. The test can also rule out nerve entrapment syndromes like carpal tunnel, ulnar nerve entrapment or brachial plexitis. These syndromes can have similar painful arm symptoms, like a cervical herniation.
WHAT ARE THE TREATMENT OPTIONS FOR A CERVICAL HERNIATED DISC?
Most people that suffer from neck, shoulder or arm pain do not require surgery and can manage their pain with conservative medications and conservative exercise, physical therapy or sometimes chiropractic therapy.
CONSERVATIVE DISC TREATMENT OPTIONS
Medications – A herniated disc in the cervical spine is caused by first, the pinching of the spinal cord or nerve root and second, the inflammation associated with the disc itself. The following are recommended to provide relief:
- Anti-inflammatory Medications such as ibuprofen or Naproxen (Advil, Aleve, Motrin) or COX-2 inhibitors such as Celebrex and Mobic are very effective pain relievers.
- Oral Steroids such as prednisone or Medrol Dose Pak, are only recommended for a short period of one week.
Physical Therapy – Physical and occupational therapy is highly recommended after acute pain improves. A therapist can develop a program using heat, cold and electrotherapy to help alleviate pain, increase strength, and mobility, and promote healing. A successful rehabilitation program can also help to prevent further injuries.
Cervical Traction – A physical therapist or at home traction devices can help reduce the pressure of a herniated disc. However, it does not work for everyone.
Chiropractic Therapy – Professional chiropractic gentle manual manipulation may help reduce the joint dysfunction and associated pain.
Activity Modification – Modifying activities and exercises that may exacerbate the herniated disc may reduce the stress and pain in the neck, shoulders, and arms. These activities may include heavy lifting above the head, running, tennis or any exercise that puts stress on the neck from increased vibration and compression to the cervical spine.
NON-OPERATIVE TREATMENT OPTIONS FOR A CERVICAL HERNIATED DISC
Pain Management – nerve blocks and steroid injections work well to pinpoint pain generators in the cervical spine and also provide therapeutic pain relief. If injections are effective but relief is short-term, interventional procedures such as the medial branch radiofrequency ablation are often recommended by pain management physicians.
LEAST INVASIVE SURGICAL OPTIONS TO TREAT CERVICAL DISC HERNIATION
Endoscopic Rhizotomy – Through a ½ inch incision our surgeon targets small peripheral nerves in the facet joints of the cervical spine with an endoscope and an HD camera. Through the scope, these nerves can be seen and ablated with a radiofrequency probe. Results have been very favorable in providing relief and for some patients in delaying further surgical intervention.
MINIMALLY INVASIVE SURGICAL OPTIONS TO TREAT CERVICAL DISC HERNIATION
CERVICAL ARTIFICIAL DISC REPLACEMENT (ADR) – was developed as an alternative to spinal fusion. The procedure has a 90% success rate at given patients relief of pain in the neck, shoulders, and hands. In addition, the ADR preserves natural motion of the neck and reduces likelihood of additional cervical surgery unlike cervical spinal fusion.
ANTERIOR CERVICAL DISCECTOMY AND FUSION (ACDF) – The ACDF surgery completely removes the entire disc including the herniated portion thus removing pressure on the spinal cord and spine exiting nerves. This procedure has been used successfully, for over 30 years, with a 90 percent success rate at relieving painful conditions of the neck.
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